Reducing disparities in colorectal cancer screening in Vietnamese Americans

描述（由申请人提供）：越南裔美国人的结直肠癌（CRC）筛查率低于非西班牙裔白人。与我们降低结直肠癌发病率和死亡率的长期目标一致，我们建议传播一种以证据为基础的非专业卫生工作者（LHW）干预，并支持媒体活动（media），以增加贫困和医疗服务不足人群的结直肠癌筛查。我们将使用路径框架、社区参与研究过程和创新扩散理论来指导我们的干预、社区参与和传播方法。本研究的具体目的是：1)评估CRC LHW +媒体干预在增加从未进行过CRC筛查的50至74岁越南裔美国人中CRC筛查的有效性；2)确定CRC筛查的预测因素；3)评估社区参与的过程。在使用认知测试方法开发文化和语言上合适的健康教育材料和调查工具的形成性研究之后，我们将在加利福尼亚州圣克拉拉县50-74岁的越南裔美国人中进行一项集群随机试验，这些人在招募前从未进行过CRC筛查测试。我们将跟踪两个纵向队列，其中我们将对参与者的知识、意图和行为进行干预前调查，以了解CRC筛查；在实验组实施结直肠癌筛查教育课程，在对照组实施营养教育课程；并进行干预后调查。这两个队列将分别包括150名男性和150名女性，总样本量为600人。媒体干预部分将通过印刷和电子媒体分发越南语卫生教育材料。我们将通过比较干预前和干预后调查的筛查频率来评估干预的有效性。为了检验我们关于干预对筛查活动影响的主要假设，我们将使用z检验。我们还将采用逻辑回归模型来检验干预的效果，并确定CRC筛查的预测因素。此外，我们将对干预措施和社区参与进行过程评估。如果这种干预被发现是有效的，这种LHW模型可以应用于健康促进项目，以进一步减少越南裔美国人CRC筛查的差异，并在其他行为目标和环境中进行评估，以减少其他贫困和服务不足人群的健康差异。

DESCRIPTION (provided by applicant): Colorectal cancer (CRC) screening rates in Vietnamese Americans are lower than those in non-Hispanic whites. Consistent with our long-term goal of reducing morbidity and mortality caused by colorectal cancer, we propose to disseminate an evidence-based lay health worker (LHW) intervention supported by a media campaign (Media) to increase CRC screening in this poor and medically underserved population. We will use the Pathways Framework, Community-Based Participatory Research process, and Diffusion of Innovations Theory to guide our approach to the intervention, community participation, and dissemination. The specific aims of this study are to: 1) evaluate the effectiveness of a CRC LHW + Media intervention in increasing CRC screening among Vietnamese Americans aged 50 to 74 who have never had a CRC screening test, 2) identify predictors of CRC screening, and 3) evaluate the process of community participation. Following formative research using a cognitive testing approach to develop culturally and linguistically appropriate health education materials and survey instruments, we will conduct a cluster randomized trial among Vietnamese Americans aged 50-74 in Santa Clara County California, who have never had a CRC screening test prior to recruitment. We will follow two longitudinal cohorts among whom we will conduct a pre-intervention survey of participants' knowledge, intention, and behavior as regards CRC screening; implement CRC screening educational sessions in an experimental group and nutrition educational sessions in a comparison group; and conduct a post-intervention survey. Each of the two cohorts will include 150 men and 150 women to have a total sample size of 600. The media intervention component will distribute Vietnamese-language health education materials through print and electronic media. We will evaluate the effectiveness of the intervention by comparing the frequency of screening using pre- and post-intervention surveys. To test our primary hypothesis regarding the effects of the intervention on screening activity, we will use Z-tests. We will also employ logistic regression models to test the effects of the intervention and to identify predictors for CRC screening. In addition, we will conduct process evaluation of the intervention and community participation. If this intervention is found to be effective, this LHW model could be applied in health promotion programs to further reduce disparities in CRC screening in Vietnamese Americans and evaluated in other behavioral objectives and settings to reduce health disparities in other poor and underserved populations.